Subcutaneous ICD extraction feasible, not linked to complications
Key takeaways:
- Subcutaneous implantable cardioverter defibrillators can be extracted safely and feasibly.
- S-ICD extraction was linked to shorter hospital stays and less use of antibiotics vs. extraction of a transvenous ICD.
Extraction of a subcutaneous implantable cardioverter defibrillator was safe and feasible and produced no complications, according to registry data presented at Heart Rhythm 2023.
The researchers analyzed 71 patients implanted with the subcutaneous ICD (Emblem MRI S-ICD, Boston Scientific) included in the Rhythm Direct registry who required extraction of their device between 2013 and 2022; the total number of patients in the registry was 2,718.
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“Although the use of the S-ICD is associated with fewer complications, data on their management and outcome are few,” Paolo De Filippo, MD, from the arrhythmology unit at Ospedale Papa Giovanni XXIII in Bergamo, Italy, told Healio. “We undertook this study to investigate acute and midterm outcomes of S-ICD system extraction within a large multicenter registry by describing current intraprocedural, peri- and postoperative practice.”
Among the cohort, the mean age was 49 years, 87% were men, 17 patients required an extraction due to infection and the median time from implantation to extraction was 22 months.
All patients had successful extraction with no complications, and the median time of the procedure was 40 minutes, according to the researchers.
In 84% of patients, the lead could be removed with simple manual traction, whereas one patient required an additional parasternal incision and 11 required a mechanical sheath, De Filippo and colleagues found. The median dwell time was shorter in those who had removal with simple manual traction compared with those who had removal by other means (20 months vs. 30 months; P = .032).
“The kind of surgery itself made the possibility to extract lead and can in a straightforward way; moreover, the tissue reaction in the subcutaneous space is more predictable than inside the venous vasculature,” De Filippo told Healio. “Standard polypropylene non-powered sheaths (from 10F to 13.1F), usually employed for transvenous lead extraction, were successfully used [when simple manual traction was not enough]. Since this occurred more frequently in patients who had systems implanted for a longer time, operators could benefit from having these tools available in case of extraction of an S-ICD system implanted for more than 2 years.”
In a control group of 135 patients requiring extraction of a single-chamber transvenous ICD (67 of whom required extraction due to infection), all had successful extraction with no complications, but only 16% could be extracted with simple traction with locking stylets, according to the researchers.
Among patients who had extraction for reasons other than infection, median hospitalization time was shorter in the S-ICD group than in the transvenous group (2 days vs. 3 days; P = .001), the researchers found.
Among patients who had extraction for infection, compared with the transvenous group, the S-ICD group had shorter median hospitalization time (3 days vs. 10 days; P < .001), shorter median duration of antibiotic therapy (10 days vs. 18 days; P = .001), less use of IV antibiotics (0% vs. 67%; P < .001) and more frequent reimplantation during the same procedure (29% vs. 3%; P = .003), De Filippo and colleagues found.
In both groups, there were no long-term complications during a median of 21 months except for one patient in the transvenous group who had infection recurrence.
“We think that our data strongly suggest that, in case of need, extraction of an S-ICD can now be unambiguously seen as a safe procedure that can be performed with a simple approach and very high efficacy,” De Filippo told Healio. “From now on, especially in patients that are thought to be in a relatively long future candidate for biventricular or double-chamber upgrading, the S-ICD could be regarded as a valid alterative for first ICD implant (eg, young patients with HF with reduced ejection fraction and incomplete left bundle branch block at time of implant).”
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De Filippo P, et al. Abstract CI-452765-1. Presented at: Heart Rhythm 2023; May 19-21, 2023; New Orleans (hybrid meeting).